This rating schedule is primarily a guide in the evaluation of disability
resulting from all types of diseases and injuries encountered as a result of or
incident to military service. The percentage ratings represent as far as can
practicably be determined the average impairment in earning capacity resulting
from such diseases and injuries and their residual conditions in civil
occupations. Generally, the degrees of disability specified are considered
adequate to compensate for considerable loss of working time from exacerbations
or illnesses proportionate to the severity of the several grades of disability.
For the application of this schedule, accurate and fully descriptive medical
examinations are required, with emphasis upon the limitation of activity imposed
by the disabling condition. Over a period of many years, a veteran's disability
claim may require reratings in accordance with changes in laws, medical
knowledge and his or her physical or mental condition. It is thus essential,
both in the examination and in the evaluation of disability, that each
disability be viewed in relation to its history.

Different examiners, at different times, will not describe the same
disability in the same language. Features of the disability which must have
persisted unchanged may be overlooked or a change for the better or worse may
not be accurately appreciated or described. It is the responsibility of the
rating specialist to interpret reports of examination in the light of the whole
recorded history, reconciling the various reports into a consistent picture so
that the current rating may accurately reflect the elements of disability
present. Each disability must be considered from the point of view of the
veteran working or seeking work. If a diagnosis is not supported by the findings
on the examination report or if the report does not contain sufficient detail,
it is incumbent upon the rating board to return the report as inadequate for
evaluation purposes.

It is the defined and consistently applied policy of the Department of
Veterans Affairs to administer the law under a broad interpretation, consistent,
however, with the facts shown in every case. When after careful consideration of
all procurable and assembled data, a reasonable doubt arises regarding the
degree of disability such doubt will be resolved in favor of the claimant. See
§3.102 of this chapter.

The element of the weight to be accorded the character of the veteran's
service is but one factor entering into the considerations of the rating boards
in arriving at determinations of the evaluation of disability. Every element in
any way affecting the probative value to be assigned to the evidence in each
individual claim must be thoroughly and conscientiously studied by each member
of the rating board in the light of the established policies of the Department
of Veterans Affairs to the end that decisions will be equitable and just as
contemplated by the requirements of the law.

Where there is a question as to which of two evaluations shall be applied,
the higher evaluation will be assigned if the disability picture more nearly
approximates the criteria required for that rating. Otherwise, the lower rating
will be assigned.

Mere congenital or developmental defects, absent, displaced or supernumerary
parts, refractive error of the eye, personality disorder and mental deficiency
are not diseases or injuries in the meaning of applicable legislation for
disability compensation purposes.

The basis of disability evaluations is the ability of the body as a whole, or
of the psyche, or of a system or organ of the body to function under the
ordinary conditions of daily life including employment. Whether the upper or
lower extremities, the back or abdominal wall, the eyes or ears, or the
cardiovascular, digestive, or other system, or psyche are affected, evaluations
are based upon lack of usefulness, of these parts or systems, especially in
self-support. This imposes upon the medical examiner the responsibility of
furnishing, in addition to the etiological, anatomical, pathological, laboratory
and prognostic data required for ordinary medical classification, full
description of the effects of disability upon the person's ordinary activity. In
this connection, it will be remembered that a person may be too disabled to
engage in employment although he or she is up and about and fairly comfortable
at home or upon limited activity.

The repercussion upon a current rating of service connection when change is
made of a previously assigned diagnosis or etiology must be kept in mind. The
aim should be the reconciliation and continuance of the diagnosis or etiology
upon which service connection for the disability had been granted. The relevant
principle enunciated in §4.125, entitled “Diagnosis of mental disorders,” should
have careful attention in this connection. When any change in evaluation is to
be made, the rating agency should assure itself that there has been an actual
change in the conditions, for better or worse, and not merely a difference in
thoroughness of the examination or in use of descriptive terms. This will not,
of course, preclude the correction of erroneous ratings, nor will it preclude
assignment of a rating in conformity with §4.7.

The evaluation of the same disability under various diagnoses is to be
avoided. Disability from injuries to the muscles, nerves, and joints of an
extremity may overlap to a great extent, so that special rules are included in
the appropriate bodily system for their evaluation. Dyspnea, tachycardia,
nervousness, fatigability, etc., may result from many causes; some may be
service connected, others, not. Both the use of manifestations not resulting
from service-connected disease or injury in establishing the service-connected
evaluation, and the evaluation of the same manifestation under different
diagnoses are to be avoided.

The ability to overcome the handicap of disability varies widely among
individuals. The rating, however, is based primarily upon the average impairment
in earning capacity, that is, upon the economic or industrial handicap which
must be overcome and not from individual success in overcoming it. However, full
consideration must be given to unusual physical or mental effects in individual
cases, to peculiar effects of occupational activities, to defects in physical or
mental endowment preventing the usual amount of success in overcoming the
handicap of disability and to the effect of combinations of disability. Total
disability will be considered to exist when there is present any impairment of
mind or body which is sufficient to render it impossible for the average person
to follow a substantially gainful occupation; Provided, That permanent
total disability shall be taken to exist when the impairment is reasonably
certain to continue throughout the life of the disabled person. The following
will be considered to be permanent total disability: the permanent loss of the
use of both hands, or of both feet, or of one hand and one foot, or of the sight
of both eyes, or becoming permanently helpless or permanently bedridden. Other
total disability ratings are scheduled in the various bodily systems of this
schedule.

(a) Total disability ratings for compensation may be assigned, where the
schedular rating is less than total, when the disabled person is, in the
judgment of the rating agency, unable to secure or follow a substantially
gainful occupation as a result of service-connected disabilities: Provided
That, if there is only one such disability, this disability shall be ratable
at 60 percent or more, and that, if there are two or more disabilities, there
shall be at least one disability ratable at 40 percent or more, and sufficient
additional disability to bring the combined rating to 70 percent or more. For
the above purpose of one 60 percent disability, or one 40 percent disability in
combination, the following will be considered as one disability: (1)
Disabilities of one or both upper extremities, or of one or both lower
extremities, including the bilateral factor, if applicable, (2) disabilities
resulting from common etiology or a single accident, (3) disabilities affecting
a single body system, e.g. orthopedic, digestive, respiratory,
cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in
action, or (5) multiple disabilities incurred as a prisoner of war. It is
provided further that the existence or degree of nonservice-connected
disabilities or previous unemployability status will be disregarded where the
percentages referred to in this paragraph for the service-connected disability
or disabilities are met and in the judgment of the rating agency such
service-connected disabilities render the veteran unemployable. Marginal
employment shall not be considered substantially gainful employment. For
purposes of this section, marginal employment generally shall be deemed to exist
when a veteran's earned annual income does not exceed the amount established by
the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold
for one person. Marginal employment may also be held to exist, on a facts found
basis (includes but is not limited to employment in a protected environment such
as a family business or sheltered workshop), when earned annual income exceeds
the poverty threshold. Consideration shall be given in all claims to the nature
of the employment and the reason for termination.

(Authority: 38 U.S.C. 501)

(b) It is the established policy of the Department of Veterans Affairs that
all veterans who are unable to secure and follow a substantially gainful
occupation by reason of service-connected disabilities shall be rated totally
disabled. Therefore, rating boards should submit to the Director, Compensation
and Pension Service, for extra-schedular consideration all cases of veterans who
are unemployable by reason of service-connected disabilities, but who fail to
meet the percentage standards set forth in paragraph (a) of this section. The
rating board will include a full statement as to the veteran's service-connected
disabilities, employment history, educational and vocational attainment and all
other factors having a bearing on the issue.

All veterans who are basically eligible and who are unable to secure and
follow a substantially gainful occupation by reason of disabilities which are
likely to be permanent shall be rated as permanently and totally disabled. For
the purpose of pension, the permanence of the percentage requirements of §4.16
is a requisite. When the percentage requirements are met, and the disabilities
involved are of a permanent nature, a rating of permanent and total disability
will be assigned if the veteran is found to be unable to secure and follow
substantially gainful employment by reason of such disability. Prior employment
or unemployment status is immaterial if in the judgment of the rating board the
veteran's disabilities render him or her unemployable. In making such
determinations, the following guidelines will be used:

(a) Marginal employment, for example, as a self-employed farmer or other
person, while employed in his or her own business, or at odd jobs or while
employed at less than half the usual remuneration will not be considered
incompatible with a determination of unemployability, if the restriction, as to
securing or retaining better employment, is due to disability.

(b) Claims of all veterans who fail to meet the percentage standards but who
meet the basic entitlement criteria and are unemployable, will be referred by
the rating board to the Veterans Service Center Manager or the Pension
Management Center Manager under §3.321(b)(2) of this chapter.

A permanent and total disability rating under the provisions of §§4.15, 4.16
and 4.17 will not be precluded by reason of the coexistence of misconduct
disability when:

(a) A veteran, regardless of employment status, also has innocently acquired
100 percent disability, or

(b) Where unemployable, the veteran has other disabilities innocently
acquired which meet the percentage requirements of §§4.16 and 4.17 and would
render, in the judgment of the rating agency, the average person unable to
secure or follow a substantially gainful occupation.

A veteran may be considered as unemployable upon termination of employment
which was provided on account of disability, or in which special consideration
was given on account of the same, when it is satisfactorily shown that he or she
is unable to secure further employment. With amputations, sequelae of fractures
and other residuals of traumatism shown to be of static character, a showing of
continuous unemployability from date of incurrence, or the date the condition
reached the stabilized level, is a general requirement in order to establish the
fact that present unemployability is the result of the disability. However,
consideration is to be given to the circumstances of employment in individual
claims, and, if the employment was only occasional, intermittent, tryout or
unsuccessful, or eventually terminated on account of the disability, present
unemployability may be attributed to the static disability. Where
unemployability for pension previously has been established on the basis of
combined service-connected and nonservice-connected disabilities and the
service-connected disability or disabilities have increased in severity, §4.16
is for consideration.

I served in Vietnam as a helicopter pilot in 1965 and 1966. I have a 100% disability rating as a result of PTSD, ischemic heart disease including cornary artery disease, loss of a vital organ, hearing and prostate cancer. I get annual letters from the VA, Winston Salem, NC stating I am permanent and total, but when I applied for CHAMPSVA assistance for my wife, I was told I do not have a P and T rating. I am told I need to apply for unemployability comp via form 21-8940. Another source said based on my rating and service connected disabilities, I should be P and T.